Nutrition Diagnosis
Key Points
- Nutrition Diagnosis is the second step in the Nutrition Care Process.
- Nutrition Diagnosis is communicated through a PES statement.
- The Nutrition Diagnosis can be resolved or improved by a nutrition intervention.
The purpose of Nutrition Diagnosis is to identify and label existing nutrition problems that the RDN is responsible for treating.
Nutrition diagnosis terminology is categorized into four domains:
Intake consists of terms that describe nutrition problems related to intake of energy, nutrients, fluids and bioactive substances through oral diet or nutrition support.
Clinical includes nutrition diagnoses that capture nutrition problems related to medical or physical conditions.
Behavioral-Environmental Nutrition Diagnosis includes nutrition diagnoses that describe nutritional problems related to knowledge, attitudes/beliefs or physical environment.
Nutrition Situation includes nutrition related findings that provide additional content relevant to a person;s nutrition care.
The nutrition diagnosis is communicated as a structured sentence called a "PES Statement." The PES statement includes three distinct parts—Problem (Nutrition Diagnosis Term), Etiology (root cause of the problem) and Signs and Symptoms (proof of the problem and evidence from nutrition assessment data)—and follows the format "[Problem] related to [Etiology] as evidenced by [Signs and Symptoms].
Specific questions RDNs should ask when evaluating each section of the PES statements include:
- For the problem, can the RDN resolve or improve the client's nutrition diagnosis?
- For the etiology, is this the most specific root cause that the RDN can resolve or improve with a nutrition intervention?
- For the signs and symptoms, will measuring the signs and symptoms indicate if the problem is resolved or improved?
- Are the signs and symptoms specific?
Critical Thinking in Nutrition Diagnosis
Use evidence and reasoning to succinctly state each problem with a PES statement.
Examples: Total energy intake supports energy intake diagnoses. Low food availability and low food variation are two problems: Food insecurity, Unbalanced diet pattern.
More than one data point supports a diagnosis and makes sense for the population.
Example: Malnutrition is supported by specific data (eg, muscle loss, poor intake, unintentional weight loss) over a defined time.
Data that eliminate a problem can narrow choices to a more likely problem.
Example: Constipation is a concern. Fluid intake is sufficient and ruled out as a factor. Fiber intake is assessed to consider diagnosis of Inadequate fiber intake.
Ask what barrier(s) exist to solving the problem and why promotes root cause identification.
Example: Need for behavior change identified. Assessment reveals client in precontemplation stage of change.
Data that change due to a nutrition intervention are needed for demonstrating an impact.
Example: Timing and composition of evening snack to impact morning fasting glucose in a client with diabetes.
Visit the Academy's eNCPT for additional training and subscription information for using the terminology in Electronic Health Record (EHR) or Electronic Medical Record (EMR) systems.
Join the Academy
Members of the Academy of Nutrition and Dietetics receive exciting benefits including complimentary continuing professional education opportunities, discounts on events and products in eatrightSTORE.org, invitations to exclusive members-only events and more!